HomeMy WebLinkAbout92-2822
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
N<1
2822i?
Date /1.trO '-J;[
G"DI~ ElE~ PlUM~
:::::,~s:~'f0:6~Ai!lL~
MECH~ Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Parcell.D. #
Zoning: Energy Code:
Description of W:;;; ~~,.y...;,~~tM
Radon Gas:
~ ,o? A f(} P:'..--J .-j- _ .;\-<
j7 /
~
NO OCCUPANCY BEFORE C.O.
FINAL
DATE
Complete Plans. Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Insp ctor
City License Registration #
State Certified License#
77
,
Permit Fee
Signature
Company
Address
Telephone#
Valuation or
Contract Price ~ 0 ..3'~:- t?()
Ftr. Tp. Serv,
Pre SLB ~ Rough In
Lintel ~ -LJ-C}Z;J.,'iJ -Meter Can
FRM. Const, Pole
Insul. CL Pool
WL Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15,00) shall be made for each trip for each trade:
a. Wrong Address
b, Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site,
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
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APPLICATION FOR PERNIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT ~Cl.M \
ADDRESS 8.3 d--. 6
OWNER ~h.o r-t
-5037
'-- 'S~~>-
\.Ju.)~ 9~
I:'~~ n<..f\..p r
GAil Dll1~
PHONE
5lc>7-,f S cf ()
JOB LOCATION
LOT SIZE_X
AREA SQ,FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I.D.4F
WORK PROPOSED:____New Construction ____Addition ----Alteration ____Repair ____Install
____Sign/Temp.
____Sign
_Move
_Demolish
PROPOSED USE: ____Single Family
_M/F
_4~ of tlni ts
,____M I H
_Commercial
_Indust.
_Swim, Pool
Other
,
____Restaurant & Health Department Approval
BuiLDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FOR./1S.'''':
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
**COPY OF CONTRACT REQUIRED.
PERMITS REOUESTED
____BUILDING
$
Valuation of Total Construction
____ELECTRICAL
..'
_MECHANICAL
AMP Service
Florida Power Corp.
_H.R.E.C.
$
Valuation of Mechanical Installation
____PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: ____Block
____Frame ____Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
CONTRACTOR SECTION ~.
Company 't:.: 11) Y
State Cert, or Regist, #
City License Registration #
***********************************
COu.~-hu..(~ '-
Signature
ELECTRICIAN Company
State Cert. or Regist. #
Signature City License Registration ~
******************************************
PLUMBER Company
State Cert. or Regist. #
Signature City License Registration #
**********************~*******************
MECHANICAL Company
State Cert. or Regist. #
Signature City License Registration iF
******************************************
OTHER Company
State Cert. or Regist. #
Signature City License Registration 4F
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERM!T AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this pertit may be subject to "deed restricti~n5" which lay be lore restrictive than City
regulations. The undersigned assutes responsibility for COlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor lay be
cited for a tisdeaeanor violation under state lall. If the owner Dr intended contractor are uncertain as to what licensing
requiretents tay apply for the intended llork, they are advised to contact the City of 2ephyrhills Building Department, (813)
7BB-bb 11.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s} sign portions of the
"Contractor Sections" of this application for llhich they will be responsible. If you, as the owner sign as the contracto,-,
you are indicating that you, rather than the contractor, are responsible for the worK. If the contractor wishes you to sIgn
as contractor that may be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEE~.
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law - Homeowner's ProtectIon
Guide" prepared by the Florida Department of Agriculture and Consuter Affairs. if the applicant is SOleone other than tee
"owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it tel the
"ollner" prior to cOllencement.
:~
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will be done in cOlpliance with all
a~plicable laws regulating construction, zoning, and land development.
I
Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no worK or
installation has cOlmenced prior to issuance of a permit and that all work will be perforled to leet standards of all l~"s
regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies lay apply to the intended work, and that it is
IY responsibility to identify what actions I must take to be in cOlpliance. Such agencies include but are not limited tCI:
I Departlent of Environmental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treatment
I Southwest Florida Water HanaQement District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
I Army Corps of EnQineers - Seallalls, Docks, Navigable Waterways
I De artlent of Health L Rehabilitative Services Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
I Environmental Protection AQency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a "colpensating volule" will be submitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alte'l or
set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official frol thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall becole irlvalid
unless the work authorized by such permit is cOllenced within six tonths of issuance, or if work authorized by the per~lt is
suspended or abandoned for a period of six months after the tile the work is COlienced. One 90 day extension of tile, ~2, be
allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection lust be logged during each six lonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT HAY RESULT IN YOUR PAYING THICE FOR IMPROVEMENTS TO i0UR
PROPERTY. IF YOU INTEND TO DBTAIN FINANCING, CDNSUlT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: CONTRACTOR
was acknowledged
, 19_ by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
before me this 19_____ by
who is personally known to me Dr who has
produced
as identification and who did/did not
take an oath.
who is personally known to me Dr who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Signature)
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC